UR 202/ NUR202 Exam 2 –
N
Maternal-Newborn Nursing Guide
ACTUAL EXAM 2026/2027 |
Maternal-Newborn Nursing Guide |
Verified Q&A | Pass Guaranteed - A+
Graded
ART A – MULTIPLE CHOICE (Q1–60)
P
Q1 (Intrapartum – Prolapsed Cord): A client at 38 weeks gestation is admitted with sudden
onset of severe fetal bradycardia (FHR 60 bpm) after her membranes ruptured spontaneously.
Vaginal examination reveals a pulsating cord alongside the fetal head. What is the nurse's
immediate priority action?
A. Apply oxygen via face mask at 10 L/min
B. Call the provider to request an emergency cesarean birth
C. Use two fingers to manually elevate the presenting part off the cord
D. Place the client in a knee-chest position
[CORRECT] C
Rationale: ACOG and AWHONN guidelines identify manual elevation of the presenting part as
the immediate life-saving intervention for umbilical cord prolapse to restore fetal oxygenation;
the cord must be relieved of compression within seconds to prevent fetal hypoxia. Option D
(knee-chest) is a supportive measure but does not directly relieve compression, and delaying
manual elevation to reposition the client wastes critical seconds. Clinical pearl: Keep fingers in
place continuously until delivery—never remove them to check FHR or reposition.
Q2 (Labor & Delivery – Stages of Labor): A primigravida client is admitted at 4 cm dilation, 80%
effacement, -1 station, with regular contractions every 5 minutes lasting 45 seconds. She is
coping well and requests no medication. According to the 2026 ACOG updated labor
progression guidelines, at what cervical dilation does active labor now begin?
A. 3 cm
B. 4 cm
C. 5 cm
D. 6 cm
[CORRECT] D
Rationale: The 2026 ACOG update reaffirms that active labor begins at 6 cm dilation for most
nulliparous women, replacing the outdated 4 cm threshold to reduce unnecessary interventions
like early augmentation and cesarean birth. Option B (4 cm) reflects the old Friedman curve and
,is a common distractor on legacy exams; the updated guideline prevents premature diagnosis of
labor dystocia. Clinical pearl: Fortis students must use 6 cm as the active labor benchmark for
NUR 202—this is a high-yield exam point.
Q3 (EFM – Deceleration Patterns): During labor, the FHR tracing shows decelerations that
begin at the onset of the contraction, reach their nadir at the peak of the contraction, and return
to baseline by the end of the contraction. The shape mirrors the contraction waveform. What is
the correct interpretation and management?
A. Late decelerations—prepare for emergency delivery
B. Variable decelerations—administer oxygen and change maternal position
C. Early decelerations—reassuring pattern, continue routine monitoring
D. Prolonged deceleration—initiate intrauterine resuscitation
[CORRECT] C
Rationale: Early decelerations are benign, head-compression patterns characterized by their
gradual onset, nadir at peak contraction, and return to baseline by contraction end; they require
no intervention beyond routine monitoring per NICHD Category I criteria. Option A (late
decelerations) describes a non-reassuring pattern with nadir after contraction peak, indicating
uteroplacental insufficiency; confusing early and late decelerations is the most common EFM
error. Clinical pearl: "Early = Easy = Benign"—mirror the contraction shape, and you mirror the
correct answer.
Q4 (EFM – Variability): The nurse is reviewing a fetal monitor strip and notes an FHR baseline
of 140 bpm with fluctuations of 10–25 bpm above and below the baseline. There are no
decelerations. How should this tracing be categorized per NICHD three-tier system?
A. Category I (Normal)
B. Category II (Indeterminate)
C. Category III (Abnormal)
D. Category IV (Critical)
[CORRECT] A
Rationale: Moderate variability (6–25 bpm) with a normal baseline (110–160 bpm) and no late or
variable decelerations defines a NICHD Category I (normal) tracing, associated with normal
fetal acid-base status. Option B (Category II) is incorrect because moderate variability with
normal baseline and no decelerations meets all criteria for Category I; Category II requires
some non-reassuring element. Clinical pearl: Category I = "All is Well"—normal baseline +
moderate variability + no bad decels = reassurance.
Q5 (Pain Management – Epidural): A client in active labor at 7 cm dilation requests an epidural.
After placement, the nurse notes the client's blood pressure has dropped from 124/78 to 88/52
mmHg. What is the priority nursing intervention?
A. Turn the client to the left lateral position
B. Administer a bolus of IV normal saline and ephedrine per protocol
C. Increase the epidural infusion rate to maintain analgesia
D. Discontinue the epidural and notify the anesthesiologist
[CORRECT] B
Rationale: Hypotension from sympathetic blockade is the most common epidural complication;
the evidence-based priority is fluid resuscitation (500–1000 mL crystalloid bolus) plus a
vasopressor such as ephedrine 5–10 mg IV to restore maternal perfusion and placental blood
,flow. Option A (left lateral position) is a secondary supportive measure for uterine displacement
but does not treat the hypotension itself; fluid + vasopressor is the immediate pharmacologic
response. Clinical pearl: "Fluid first, then pressor"—never delay treating epidural hypotension as
it can cause fetal bradycardia within minutes.
Q6 (Pain Management – IV Opioids): A client in active labor receives butorphanol (Stadol) 1 mg
IV for pain. Thirty minutes later, the newborn is delivered and exhibits respiratory depression
with an APGAR of 5 at 1 minute. What is the antagonist of choice for this neonatal opioid
depression?
A. Naloxone (Narcan) 0.1 mg/kg IV/IM/ETT
B. Flumazenil (Romazicon) 0.01 mg/kg IV
C. Nalbuphine (Nubain) 0.1 mg/kg IV
D. Physostigmine 0.02 mg/kg IV
[CORRECT] A
Rationale: Naloxone is the specific opioid antagonist that reverses respiratory depression
caused by maternal butorphanol or other opioids by competitively binding to opioid receptors;
the neonatal dose is 0.1 mg/kg administered via IV, IM, or endotracheal tube. Option C
(nalbuphine) is another opioid agonist-antagonist that would worsen, not reverse, respiratory
depression—a dangerous distractor if confused with naloxone. Clinical pearl: Butorphanol and
nalbuphine have a ceiling effect on respiratory depression but still require naloxone reversal in
neonates; always have it available when giving IV opioids in labor.
Q7 (Labor Progression – Fetal Positioning): During vaginal examination, the nurse palpates the
fetal occiput anteriorly in the left lower quadrant of the maternal pelvis. The fetal back is on the
maternal left side. What is the documented fetal position?
A. Left occiput anterior (LOA)
B. Left occiput posterior (LOP)
C. Right occiput anterior (ROA)
D. Right occiput transverse (ROT)
[CORRECT] A
Rationale: LOA is the most common and optimal fetal position for vaginal delivery, defined by
the occiput (posterior fontanelle) located in the left anterior quadrant of the maternal pelvis with
the fetal back oriented left-anterior. Option B (LOP) would place the occiput in the left posterior
quadrant, causing back labor and prolonged descent; understanding quadrant placement is
essential for correct documentation. Clinical pearl: LOA = "Leave Out Anxiety"—it's the ideal
position for spontaneous delivery and lowest risk of dystocia.
Q8 (Intrapartum Complications – Preterm Labor): A client at 32 weeks gestation presents with
regular contractions every 3 minutes, cervical dilation of 3 cm, and 80% effacement. The
provider orders tocolysis. Which medication is contraindicated in this client with a history of
cardiac disease?
A. Nifedipine (Procardia)
B. Indomethacin (Indocin)
C. Terbutaline (Brethine)
D. Magnesium sulfate
[CORRECT] C
, ationale: Terbutaline is a beta-2 agonist that causes maternal tachycardia, palpitations, and
R
potential arrhythmias or myocardial ischemia, making it contraindicated in clients with
preexisting cardiac disease; nifedipine is preferred in this population. Option A (nifedipine) is
actually the recommended first-line tocolytic for cardiac patients due to its minimal
cardiovascular side effects when used short-term. Clinical pearl: "Terbutaline = Terrible for the
heart"—remember the cardiac contraindication, and that nifedipine is the safer calcium channel
blocker alternative.
Q9 (Preterm Labor – Corticosteroids): A client at 28 weeks gestation is in preterm labor. The
provider orders betamethasone 12 mg IM. What is the primary therapeutic goal of antenatal
corticosteroid administration?
A. To stop uterine contractions and delay delivery
B. To accelerate fetal lung maturation and reduce RDS risk
C. To treat suspected chorioamnionitis
D. To prevent neonatal hypoglycemia
[CORRECT] B
Rationale: Betamethasone and dexamethasone cross the placenta to stimulate fetal type II
pneumocyte surfactant production, reducing the incidence and severity of respiratory distress
syndrome (RDS) and intraventricular hemorrhage in preterm infants; optimal benefit occurs 24
hours to 7 days after the first dose. Option A describes tocolytics, not corticosteroids;
corticosteroids do not stop labor but improve neonatal outcomes if delivery occurs. Clinical
pearl: "Betamethasone = Better Breathing"—give it to any client 24+0 to 33+6 weeks with
threatened preterm delivery, even if tocolysis fails.
Q10 (PROM/PPROM): A client at 35 weeks gestation reports a sudden gush of clear fluid from
the vagina. Sterile speculum examination confirms pooling of fluid, nitrazine test is positive
(blue), and ferning is visible on microscopy. The client is afebrile with WBC 12,000/mm³. What is
the priority nursing intervention?
A. Administer broad-spectrum antibiotics immediately
B. Assess fetal heart rate and check for umbilical cord compression
C. Perform a digital vaginal examination to assess cervical dilation
D. Prepare for immediate induction of labor regardless of gestational age
[CORRECT] B
Rationale: After PROM/PPROM diagnosis, the immediate priority is fetal assessment because
the barrier against infection is lost and umbilical cord compression (from decreased fluid or cord
prolapse) can cause sudden fetal hypoxia; continuous FHR monitoring is essential. Option C
(digital examination) is contraindicated until labor is established or infection is ruled out, as it
introduces bacteria and increases chorioamnionitis risk—this is a critical safety violation. Clinical
pearl: "No fingers until labor begins"—sterile speculum only for PROM; digital exams are
reserved for active labor or delivery planning.
Q11 (Shoulder Dystocia): During delivery of a macrosomic infant, the fetal head delivers but
retracts against the perineum (turtle sign), and the anterior shoulder fails to deliver with gentle
traction. The nurse recognizes shoulder dystocia. What is the first maneuver the nurse should
assist with?
A. McRoberts maneuver
B. Suprapubic pressure
N
Maternal-Newborn Nursing Guide
ACTUAL EXAM 2026/2027 |
Maternal-Newborn Nursing Guide |
Verified Q&A | Pass Guaranteed - A+
Graded
ART A – MULTIPLE CHOICE (Q1–60)
P
Q1 (Intrapartum – Prolapsed Cord): A client at 38 weeks gestation is admitted with sudden
onset of severe fetal bradycardia (FHR 60 bpm) after her membranes ruptured spontaneously.
Vaginal examination reveals a pulsating cord alongside the fetal head. What is the nurse's
immediate priority action?
A. Apply oxygen via face mask at 10 L/min
B. Call the provider to request an emergency cesarean birth
C. Use two fingers to manually elevate the presenting part off the cord
D. Place the client in a knee-chest position
[CORRECT] C
Rationale: ACOG and AWHONN guidelines identify manual elevation of the presenting part as
the immediate life-saving intervention for umbilical cord prolapse to restore fetal oxygenation;
the cord must be relieved of compression within seconds to prevent fetal hypoxia. Option D
(knee-chest) is a supportive measure but does not directly relieve compression, and delaying
manual elevation to reposition the client wastes critical seconds. Clinical pearl: Keep fingers in
place continuously until delivery—never remove them to check FHR or reposition.
Q2 (Labor & Delivery – Stages of Labor): A primigravida client is admitted at 4 cm dilation, 80%
effacement, -1 station, with regular contractions every 5 minutes lasting 45 seconds. She is
coping well and requests no medication. According to the 2026 ACOG updated labor
progression guidelines, at what cervical dilation does active labor now begin?
A. 3 cm
B. 4 cm
C. 5 cm
D. 6 cm
[CORRECT] D
Rationale: The 2026 ACOG update reaffirms that active labor begins at 6 cm dilation for most
nulliparous women, replacing the outdated 4 cm threshold to reduce unnecessary interventions
like early augmentation and cesarean birth. Option B (4 cm) reflects the old Friedman curve and
,is a common distractor on legacy exams; the updated guideline prevents premature diagnosis of
labor dystocia. Clinical pearl: Fortis students must use 6 cm as the active labor benchmark for
NUR 202—this is a high-yield exam point.
Q3 (EFM – Deceleration Patterns): During labor, the FHR tracing shows decelerations that
begin at the onset of the contraction, reach their nadir at the peak of the contraction, and return
to baseline by the end of the contraction. The shape mirrors the contraction waveform. What is
the correct interpretation and management?
A. Late decelerations—prepare for emergency delivery
B. Variable decelerations—administer oxygen and change maternal position
C. Early decelerations—reassuring pattern, continue routine monitoring
D. Prolonged deceleration—initiate intrauterine resuscitation
[CORRECT] C
Rationale: Early decelerations are benign, head-compression patterns characterized by their
gradual onset, nadir at peak contraction, and return to baseline by contraction end; they require
no intervention beyond routine monitoring per NICHD Category I criteria. Option A (late
decelerations) describes a non-reassuring pattern with nadir after contraction peak, indicating
uteroplacental insufficiency; confusing early and late decelerations is the most common EFM
error. Clinical pearl: "Early = Easy = Benign"—mirror the contraction shape, and you mirror the
correct answer.
Q4 (EFM – Variability): The nurse is reviewing a fetal monitor strip and notes an FHR baseline
of 140 bpm with fluctuations of 10–25 bpm above and below the baseline. There are no
decelerations. How should this tracing be categorized per NICHD three-tier system?
A. Category I (Normal)
B. Category II (Indeterminate)
C. Category III (Abnormal)
D. Category IV (Critical)
[CORRECT] A
Rationale: Moderate variability (6–25 bpm) with a normal baseline (110–160 bpm) and no late or
variable decelerations defines a NICHD Category I (normal) tracing, associated with normal
fetal acid-base status. Option B (Category II) is incorrect because moderate variability with
normal baseline and no decelerations meets all criteria for Category I; Category II requires
some non-reassuring element. Clinical pearl: Category I = "All is Well"—normal baseline +
moderate variability + no bad decels = reassurance.
Q5 (Pain Management – Epidural): A client in active labor at 7 cm dilation requests an epidural.
After placement, the nurse notes the client's blood pressure has dropped from 124/78 to 88/52
mmHg. What is the priority nursing intervention?
A. Turn the client to the left lateral position
B. Administer a bolus of IV normal saline and ephedrine per protocol
C. Increase the epidural infusion rate to maintain analgesia
D. Discontinue the epidural and notify the anesthesiologist
[CORRECT] B
Rationale: Hypotension from sympathetic blockade is the most common epidural complication;
the evidence-based priority is fluid resuscitation (500–1000 mL crystalloid bolus) plus a
vasopressor such as ephedrine 5–10 mg IV to restore maternal perfusion and placental blood
,flow. Option A (left lateral position) is a secondary supportive measure for uterine displacement
but does not treat the hypotension itself; fluid + vasopressor is the immediate pharmacologic
response. Clinical pearl: "Fluid first, then pressor"—never delay treating epidural hypotension as
it can cause fetal bradycardia within minutes.
Q6 (Pain Management – IV Opioids): A client in active labor receives butorphanol (Stadol) 1 mg
IV for pain. Thirty minutes later, the newborn is delivered and exhibits respiratory depression
with an APGAR of 5 at 1 minute. What is the antagonist of choice for this neonatal opioid
depression?
A. Naloxone (Narcan) 0.1 mg/kg IV/IM/ETT
B. Flumazenil (Romazicon) 0.01 mg/kg IV
C. Nalbuphine (Nubain) 0.1 mg/kg IV
D. Physostigmine 0.02 mg/kg IV
[CORRECT] A
Rationale: Naloxone is the specific opioid antagonist that reverses respiratory depression
caused by maternal butorphanol or other opioids by competitively binding to opioid receptors;
the neonatal dose is 0.1 mg/kg administered via IV, IM, or endotracheal tube. Option C
(nalbuphine) is another opioid agonist-antagonist that would worsen, not reverse, respiratory
depression—a dangerous distractor if confused with naloxone. Clinical pearl: Butorphanol and
nalbuphine have a ceiling effect on respiratory depression but still require naloxone reversal in
neonates; always have it available when giving IV opioids in labor.
Q7 (Labor Progression – Fetal Positioning): During vaginal examination, the nurse palpates the
fetal occiput anteriorly in the left lower quadrant of the maternal pelvis. The fetal back is on the
maternal left side. What is the documented fetal position?
A. Left occiput anterior (LOA)
B. Left occiput posterior (LOP)
C. Right occiput anterior (ROA)
D. Right occiput transverse (ROT)
[CORRECT] A
Rationale: LOA is the most common and optimal fetal position for vaginal delivery, defined by
the occiput (posterior fontanelle) located in the left anterior quadrant of the maternal pelvis with
the fetal back oriented left-anterior. Option B (LOP) would place the occiput in the left posterior
quadrant, causing back labor and prolonged descent; understanding quadrant placement is
essential for correct documentation. Clinical pearl: LOA = "Leave Out Anxiety"—it's the ideal
position for spontaneous delivery and lowest risk of dystocia.
Q8 (Intrapartum Complications – Preterm Labor): A client at 32 weeks gestation presents with
regular contractions every 3 minutes, cervical dilation of 3 cm, and 80% effacement. The
provider orders tocolysis. Which medication is contraindicated in this client with a history of
cardiac disease?
A. Nifedipine (Procardia)
B. Indomethacin (Indocin)
C. Terbutaline (Brethine)
D. Magnesium sulfate
[CORRECT] C
, ationale: Terbutaline is a beta-2 agonist that causes maternal tachycardia, palpitations, and
R
potential arrhythmias or myocardial ischemia, making it contraindicated in clients with
preexisting cardiac disease; nifedipine is preferred in this population. Option A (nifedipine) is
actually the recommended first-line tocolytic for cardiac patients due to its minimal
cardiovascular side effects when used short-term. Clinical pearl: "Terbutaline = Terrible for the
heart"—remember the cardiac contraindication, and that nifedipine is the safer calcium channel
blocker alternative.
Q9 (Preterm Labor – Corticosteroids): A client at 28 weeks gestation is in preterm labor. The
provider orders betamethasone 12 mg IM. What is the primary therapeutic goal of antenatal
corticosteroid administration?
A. To stop uterine contractions and delay delivery
B. To accelerate fetal lung maturation and reduce RDS risk
C. To treat suspected chorioamnionitis
D. To prevent neonatal hypoglycemia
[CORRECT] B
Rationale: Betamethasone and dexamethasone cross the placenta to stimulate fetal type II
pneumocyte surfactant production, reducing the incidence and severity of respiratory distress
syndrome (RDS) and intraventricular hemorrhage in preterm infants; optimal benefit occurs 24
hours to 7 days after the first dose. Option A describes tocolytics, not corticosteroids;
corticosteroids do not stop labor but improve neonatal outcomes if delivery occurs. Clinical
pearl: "Betamethasone = Better Breathing"—give it to any client 24+0 to 33+6 weeks with
threatened preterm delivery, even if tocolysis fails.
Q10 (PROM/PPROM): A client at 35 weeks gestation reports a sudden gush of clear fluid from
the vagina. Sterile speculum examination confirms pooling of fluid, nitrazine test is positive
(blue), and ferning is visible on microscopy. The client is afebrile with WBC 12,000/mm³. What is
the priority nursing intervention?
A. Administer broad-spectrum antibiotics immediately
B. Assess fetal heart rate and check for umbilical cord compression
C. Perform a digital vaginal examination to assess cervical dilation
D. Prepare for immediate induction of labor regardless of gestational age
[CORRECT] B
Rationale: After PROM/PPROM diagnosis, the immediate priority is fetal assessment because
the barrier against infection is lost and umbilical cord compression (from decreased fluid or cord
prolapse) can cause sudden fetal hypoxia; continuous FHR monitoring is essential. Option C
(digital examination) is contraindicated until labor is established or infection is ruled out, as it
introduces bacteria and increases chorioamnionitis risk—this is a critical safety violation. Clinical
pearl: "No fingers until labor begins"—sterile speculum only for PROM; digital exams are
reserved for active labor or delivery planning.
Q11 (Shoulder Dystocia): During delivery of a macrosomic infant, the fetal head delivers but
retracts against the perineum (turtle sign), and the anterior shoulder fails to deliver with gentle
traction. The nurse recognizes shoulder dystocia. What is the first maneuver the nurse should
assist with?
A. McRoberts maneuver
B. Suprapubic pressure
